冠狀動脈疾病
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| 冠狀動脈疾病 coronary artery disease | |
|---|---|
| 同義詞 | Atherosclerotic heart disease,[1]atherosclerotic vascular disease,[2]coronary heart disease[3] |
 | |
冠狀動脈粥樣（atherosclerosis）硬化示意圖 | |
| 醫學專科 | 心臟病學、心脏外科 |
| 症状 | 胸痛、呼吸困难[4] |
| 併發症 | 心臟衰竭、心律不整[5] |
| 肇因 | 心臟的動脈 粥樣硬化[6] |
| 風險因子 | 高血壓、吸菸、糖尿病、缺乏運動、肥胖症、高膽固醇血症[6][7] |
| 診斷方法 | 心电图、cardiac stress test, coronary computed tomographic angiography, coronary angiogram[8] |
| 預防 | 健康的飲食、規律運動、維持健康的體重、不吸菸[9] |
| 治療 | Percutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG)[10] |
| 藥物 | Aspirin, beta blockers, nitroglycerin[10] |
| 盛行率 | 1.1 億 (2015)[11] |
| 死亡數 |
|
| 冠狀動脈疾病 | |
|---|---|
| 分类和外部资源 | |
| 醫學專科 | 心臟內科、心脏外科 |
ICD-10 | I20 -I25 |
ICD-9-CM | 410-414, 429.2 |
| MedlinePlus | 007115 |
| eMedicine | radio/192 |
| Patient UK | 冠狀動脈疾病 |
| MeSH | D003324 |
冠狀動脈疾病（英语：coronary artery disease, CAD）又稱為缺血性心臟病或簡稱冠心病（英语：ischemic heart disease, IHD）[13]、冠狀動脈粥狀硬化心臟病[14]、冠狀動脈粥狀硬化心血管疾病（英语：coronary atherosclerotic heart disease, CAHD）[15]和冠狀動脈心臟病（英语：coronary heart disease）[16]，是一群包含穩定型心絞痛、非穩定型心絞痛、心肌梗塞和猝死的疾病[17]。冠狀動脈疾病是最常見的心臟血管疾病[18]。常見的症狀包括胸痛或不適，有時會轉移到肩膀、手臂、背部、頸部或下顎[4]。有些人可能會有胸口灼熱的感覺[4]。通常症狀在運動或情緒壓力下出現，持續時間不超過數分鐘且休息會緩解[4]。有時會伴隨呼吸困難，有時則是毫無症狀[4]。少數人以心肌梗塞為最初的表現[5]。其他可能的併發症包含心臟衰竭或心律不整[5]。
危險因子包括：高血壓、抽菸、糖尿病、缺乏運動、肥胖、血液中膽固醇含量過高、營養不良和酗酒等[6][19]。其他的危險因子也包括憂鬱症[20]。潛在的病理機制與冠狀動脈血管的粥狀硬化有關[6]。心電圖、心臟壓力測試與冠狀動脈血管攝影是常見有助於診斷的工具[21]。
預防方式包括：健康飲食、規律運動、體重控制以及戒菸[9]。視情況合併使用藥物控制高血糖、高膽固醇或高血壓[9]。只有很有限的證據支持對低風險且沒有症狀的民眾實施篩檢[22]。最初治療和預防措施一樣，包括生活方式調整以及三高（高血糖、高膽固醇或高血壓）的控制[10][23]。進一步的藥物治療包括阿斯匹靈、乙型交感神經阻斷劑或硝酸甘油的醫療用途[10]。在病況較嚴重的情形下，會考慮進行經皮冠狀動脈介入治療或是冠狀動脈繞道手術[10][24]。對於穩定型心絞痛，經皮冠狀動脈介入治療或是冠狀動脈繞道手術，對於提升存活年限或降低未來心臟病發的效果仍不明確[25]。
冠狀動脈疾病在西元2002年是全球第一大死因[26]，也是人們住院的主要原因之一[27]。2013年也是全球死因首位，死亡人數自1990年574萬人（12%）攀升至2013年814萬人（16.8%）[18]。而隨著診斷及治療技術進步，經年齡校正後的冠狀動脈疾病死亡率自1980年至2010年則呈現下降趨勢，尤其在已開發國家更為顯著[28]。同時經年齡校正後的冠狀動脈疾病病例數在1990至2010年間亦呈現下降趨勢[29]。根據美國本土於2010年統計，冠狀動脈疾病盛行率於大於65歲族群為20%、45至64歲為7%、18至45歲為1.3%[30]。針對同一年齡層相比，男性的發生率較女性高[30]。
目录
1 治疗
1.1 健康的生活方式
1.2 药物治疗
1.3 相關治療手術
2 参考资料
3 外部連結
治疗
冠狀動脈是主動脈的分支，負責供應足夠氧和營養素予心肌。冠狀動脈被膽固醇或血凝塊阻塞時，會形成斑塊而引致心臟供血不足，患者需要接受俗稱「通波仔」的血管擴張手術以暢通血管。若冠狀動脈血液被嚴重阻塞，可引致很嚴重的後果。血液不能供應到心臟會引致劇烈的心絞痛，然後心臟會衰竭，最嚴重的可導致死亡。當冠心病發作時，須含服醫生處方的「脷底丸」（硝酸甘油），「脷底丸」可扩张血管，以增加冠状动脉血流量。冠心病發作可引致嚴重後果，應立即叫救護車求助。
健康的生活方式
卡德维尔·爱色斯坦与科林·坎贝尔证明，素食对改善冠心病和动脉硬化有很大效果。他们的同事也从许多研究中确认，素食使得许多患者的病情得以停止发展，甚至出现好转。[31][32]此类建议（增加素食，减少荤菜）已经在至少50年前就被提出了。[33][34]- 控制体重
- 停止吸烟、酗酒
- 锻炼
- 适量的鱼油（尤其是海鱼，如金枪鱼、三文鱼）摄入，以补充ω−3脂肪酸[35]
药物治疗
硝酸甘油。
阿司匹林[34]
相關治療手術
- 血管造影
- 冠狀動脈再成形術
- 冠狀動脈搭橋手術
参考资料
^ Coronary heart disease - causes, symptoms, prevention. Southern Cross Healthcare Group. [15 September 2013]. （原始内容存档于2014年3月3日）.
^ Faxon, D. P. Atherosclerotic Vascular Disease Conference: Executive Summary: Atherosclerotic Vascular Disease Conference Proceeding for Healthcare Professionals From a Special Writing Group of the American Heart Association. Circulation. 1 June 2004, 109 (21): 2595–2604. PMID 15173041. doi:10.1161/01.CIR.0000128517.52533.DB.
^ Coronary heart disease. NIH. [15 September 2013].
^ 4.04.14.24.34.4 What Are the Signs and Symptoms of Coronary Heart Disease?. http://www.nhlbi.nih.gov/. September 29, 2014 [23 February 2015].
^ 5.05.15.2 Coronary Artery Disease (CAD). cdc.gov. March 12, 2013 [23 February 2015].
^ 6.06.16.26.3 Mendis, Shanthi; Puska,, Pekka; Norrving, Bo. Global atlas on cardiovascular disease prevention and control (PDF) 1st ed. Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. 2011: 3–18. ISBN 9789241564373. 引文格式1维护：冗余文本 (link)
^ 引用错误：没有为名为Meh2014的参考文献提供内容
^ 引用错误：没有为名为NIH2014Diag的参考文献提供内容
^ 9.09.19.2 How Can Coronary Heart Disease Be Prevented or Delayed?. http://www.nhlbi.nih.gov/. [25 February 2015].
^ 10.010.110.210.310.4 How Is Coronary Heart Disease Treated?. http://www.nhlbi.nih.gov/. September 29, 2014 [25 February 2015].
^ GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.. Lancet. 8 October 2016, 388 (10053): 1545–1602. PMC 5055577. PMID 27733282. doi:10.1016/S0140-6736(16)31678-6.
^ GBD 2015 Mortality and Causes of Death, Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.. Lancet. 8 October 2016, 388 (10053): 1459–1544. PMID 27733281. doi:10.1016/S0140-6736(16)31012-1.
^ Bhatia, Sujata K. Biomaterials for clinical applications Online-Ausg. New York: Springer. 2010: 23. ISBN 9781441969200.
^ Coronary heart disease - causes, symptoms, prevention. Southern Cross Healthcare Group. [15 September 2013].
^ Faxon, D. P. Atherosclerotic Vascular Disease Conference: Executive Summary: Atherosclerotic Vascular Disease Conference Proceeding for Healthcare Professionals From a Special Writing Group of the American Heart Association. Circulation. 1 June 2004, 109 (21): 2595–2604. doi:10.1161/01.CIR.0000128517.52533.DB.
^ Coronary heart disease. ADAM. [15 September 2013].
^ Wong, ND. Epidemiological studies of CHD and the evolution of preventive cardiology.. Nature reviews. Cardiology. May 2014, 11 (5): 276–89. PMID 24663092.
^ 18.018.1 GBD 2013 Mortality and Causes of Death, Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.. Lancet. 17 December 2014. PMID 25530442. doi:10.1016/S0140-6736(14)61682-2.
^ Mehta, PK; Wei, J; Wenger, NK. Ischemic heart disease in women: A focus on risk factors.. Trends in cardiovascular medicine. 16 October 2014. PMID 25453985.
^ Charlson, FJ; Moran, AE; Freedman, G; Norman, RE; Stapelberg, NJ; Baxter, AJ; Vos, T; Whiteford, HA. The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.. BMC medicine. 26 November 2013, 11: 250. PMID 24274053.
^ How Is Coronary Heart Disease Diagnosed?. http://www.nhlbi.nih.gov/. September 29, 2014 [25 February 2015]. [永久失效連結]
^ Desai, CS; Blumenthal, RS; Greenland, P. Screening low-risk individuals for coronary artery disease.. Current atherosclerosis reports. April 2014, 16 (4): 402. PMID 24522859.
^ Boden, WE; Franklin, B; Berra, K; Haskell, WL; Calfas, KJ; Zimmerman, FH; Wenger, NK. Exercise as a therapeutic intervention in patients with stable ischemic heart disease: an underfilled prescription.. The American journal of medicine. October 2014, 127 (10): 905–11. PMID 24844736.
^ Deb, S; Wijeysundera, HC; Ko, DT; Tsubota, H; Hill, S; Fremes, SE. Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review.. JAMA. 20 November 2013, 310 (19): 2086–95. PMID 24240936.
^ Rezende, PC; Scudeler, TL; da Costa, LM; Hueb, W. Conservative strategy for treatment of stable coronary artery disease.. World journal of clinical cases. 16 February 2015, 3 (2): 163–70. PMID 25685763.
^ Finegold, JA; Asaria, P; Francis, DP. Mortality from ischaemic heart disease by country, region, and age: Statistics from World Health Organisation and United Nations. International journal of cardiology. 2012-12-04, 168 (2): 934–45. PMID 23218570. doi:10.1016/j.ijcard.2012.10.046. 引文使用过时参数coauthors (帮助)
^ World Health Organization Department of Health Statistics and Informatics in the Information, Evidence and Research Cluster. The global burden of disease 2004 update. Geneva: WHO. 2004. ISBN 92-4-156371-0.
^ Moran, AE; Forouzanfar, MH; Roth, GA; Mensah, GA; Ezzati, M; Murray, CJ; Naghavi, M. Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study.. Circulation. 8 April 2014, 129 (14): 1483–92. PMID 24573352.
^ Moran, AE; Forouzanfar, MH; Roth, GA; Mensah, GA; Ezzati, M; Flaxman, A; Murray, CJ; Naghavi, M. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study.. Circulation. 8 April 2014, 129 (14): 1493–501. PMID 24573351.
^ 30.030.1 Centers for Disease Control and Prevention (CDC). Prevalence of coronary heart disease--United States, 2006-2010.. MMWR. Morbidity and mortality weekly report. 14 October 2011, 60 (40): 1377–81. PMID 21993341.
^ http://www.heartattackproof.com/resolving_cade.htm
^ Preventive Cardiology; 2001; 4: p171-177
^ morrison l m "diet in coronary artherosclerosis" JAMA 173; 1960; p884-888
^ 34.034.1 http://www.mayoclinic.com/health/coronary-artery-disease/DS00064/DSECTION=treatments%2Dand%2Ddrugs
^ http://www.nlm.nih.gov/medlineplus/druginfo/natural/993.html
外部連結
- 《民眾日報》2009年8月21日報導：經皮冠狀動脈血管整形術 接受度提高，轉述PChome新聞。
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